Out-of-hours care 'fails to spot meningitis'

Half of the most serious cases of childhood infections, such as meningitis, are being missed because of failures in out-of-hours care, according to a senior doctor.

Parents were being told to take feverish children home by junior staff, and many felt they could not "impose" on their doctor by returning when their children's conditions worsened, while staff on the NHS Direct phone lines were not experienced enough to diagnose properly, he said.

Anthony Harnden, a lecturer in general practice at Oxford University, said that because children can suffer fevers for many reasons, it is difficult to spot those that will develop into life-threatening conditions such as meningitis and septicaemia. But, writing in the British Medical Journal today, he claims government policy is making it harder to identify the worst cases because GPs are not providing enough frontline care. "Changes in NHS policy have led to the primary care of febrile children presenting outside office hours being delivered by an increasing number of professional groups. Doctors, nurses, staff working for NHS Direct, out-of-hours centres and A&E departments may all have different levels of skill and experience. This is a major concern because the most solid evidence for recognising clinical severity in febrile children in primary care is a global assessment by an experienced clinician." People working on phone lines such as NHS Direct could not make the kind of "holistic" diagnosis a GP could make face to face, he said.

Meningitis and septicaemia affect about 3,000 people every year in the UK. Babies, children and young adults are most at risk, and one in 10 people who get meningitis and septicaemia dies, while many more are left with disabilities. Meningitis kills more children under the age of five than any other infectious disease.

Dr Harnden said that because children suffering the infections can rapidly deteriorate, parents should not feel worried about returning to a doctor within hours of being given the all-clear.

Sue Davie, chief executive of the Meningitis Trust, said: "Children who appear unwell should be seen by an experienced medical practitioner. We always recommend that parents trust their instincts and if, after calling an out-of-hours helpline or visiting a GP, parents are still concerned, they should not hesitate to visit A&E."

Jean Challinor, associate medical director of NHS Direct, said: "Nearly 25% of our calls are about children under 16, 14% of which are about children aged zero to four years, so we have expertise in providing healthcare advice for children."

A spokeswoman for the Department of Health said the department was not aware of any evidence that the standard of out-of-hours care was worsening.